Now and Later? The Sticky Question of Lymph Node Management in Patients Receiving Preoperative Chemotherapy

Excerpt

The management of patients with breast cancer has shifted from a focus of primary locoregional control to a multidisciplinary treatment approach that includes local therapy, regional therapy, and systemic therapy. Identifying the appropriate treatment algorithm for each patient is based on the stage of disease at presentation and the ultimate goal of curing the patient of all disease. The optimal management of breast cancer requires the participation of individuals from many different fields and a clear understanding from all of our participating multidisciplinary specialists on how delivery of each treatment affects the others. Nothing exemplifies this better than the issue of lymph node management in patients receiving preoperative chemotherapy for breast cancer. Preoperative chemotherapy was initially introduced in the management of locally advanced breast cancer patients and was intended to treat occult metastases that were thought to be present at the time of diagnosis but were not demonstrable with available imaging studies. Preoperative chemotherapy converted some patients from inoperability to surgical candidacy. Indeed, the combination of surgery, chemotherapy, and radiotherapy converted a disease with a once-dismal prognosis to one that was potentially curable with this multidisciplinary approach. …